[Postoperative cerebral dysfunction]

POSTOPERATIVE COGNITIVE DISORDERS IN PATIENTS UNDER CAROTID ENDARTERECTOMY

Evaluation of the impact of carotid endarterectomy on the cognitive status of patients remains debatable, since patients with atherosclerotic lesions of the carotid arteries suffer from chronic cerebrovascular insufficiency, and changes in the cognitive status of patients after carotid endarterectomy may be due to factors such as increased blood supply to the brain, microembolism after the start of blood flow, and cerebral ischemia during cross-clamping and also the effect of various anesthesia drugs on the cognitive status in these patients is ambiguous.Purpose. To assess age-related changes in cognitive status in patients with atherosclerotic lesions of the carotid arteries in the postoperative periodMaterial and methods. Neuropsychological testing was performed in 128 patients after eversion carotid endarterectomy, divided into age groups and depending on the methods of anesthesia: Propofol group and Sevoflurane group.Results. In patients under the age of 60 years, there is an improvement in cognitive status in the early and late postoperative period, while in patients of the older age group, there is a slowdown in the progression of cognitive dysfunction in both groups of anesthesia.Conclusion. An important criterion for evaluating the surgical prevention of cerebrovascular accidents is clinical effectiveness, in particular, the impact of operations and anesthesia methods on the cognitive sphere of patients of different ages with pathology of the main arteries of the head, which determines the quality of life not only for patients, but also for relatives.

Autoimmunity in acute ischemic stroke and the role of blood-brain barrier: the dark side or the light one?

This article presents a synopsis of the current data on the mechanisms of blood-brain barrier (BBB) alteration and autoimmune response in acute ischemic stroke. Most researchers confirm the relationship between the severity of immunobiochemical changes and clinical outcome of acute ischemic stroke. Ischemic stroke is accompanied by aseptic inflammation, which alters the brain tissue and exposes the co-stimulatory molecules of the immune system and the neuronal antigens. To date, BBB is not considered the border between the immune system and central nervous system, and the local immune subsystems are found within and behind the BBB. BBB disruption contributes to the leakage of brain autoantigens and induction of secondary autoimmune response to neuronal antigens and long-term inflammation. Glymphatic system function is altered and jeopardized both in hemorrhagic and ischemic stroke types. The receptors of innate immunity (toll-like receptor-2 and toll-like receptor-4) are also involved in acute ischemia-reperfusion injury. Immune response is related to the key processes of blood clotting and fibrinolysis. At the same time, the stroke-induced immune activation may promote reparation phenomena in the brain. Subsequent research on the reduction of the acute ischemic brain injury through the target regulation of the immune response is promising.

[Characteristics of postoperative cerebral dysfunction depending on the type and position of the implanted prosthetic heart valve]

AIM

To study the prevalence and structure of postoperative cerebral dysfunction depending on the type and position of the implanted prosthetic heart valve in patients who underwent surgery for the acquired heart valve disease.

MATERIAL AND METHODS

The study included 115 patients (70 men and 45 women; 64 [56; 72] years old), who underwent elective replacement or repair surgery for the acquired heart valve disease.

RESULTS AND CONCLUSION

The postoperative cerebral dysfunction was diagnosed in 40.9% patients, including replacement in the aortic position (45.5%), in the mitral position (55%), in several positions (20%). Replacement surgery was accompanied by three clinical types of postoperative cerebral dysfunction and repair surgery - by deferred cognitive impairment only. Postoperative cerebral dysfunction after the replacement in the mitral position was more common (odds ratio 4.47, 95% confidence interval 1.21-18.35, p=0.041), including its acute clinical types - perioperative stroke and symptomatic delirium of the early postoperative period (p=0.029), compared to that after the repair heart valve surgery. After the replacement in the aortic position, acute clinical types of postoperative cerebral dysfunction were more common (p=0.036). After the replacement with biological prosthesis, symptomatic delirium of the early postoperative period was more common (p=0.047). The occurrence of the deferred cognitive impairment didn't depend on the type and position of the implanted prosthetic heart valve.

[Perioperative stroke in heart valve surgery: pathogenesis, clinical findings, diagnosis, prevention, treatment]

AIM

To study risk factors, characteristics of clinical symptoms and diagnosis, and possibilities of prevention of perioperative stroke and other clinical types of cerebral dysfunction in main types of heart valve surgery.

MATERIAL AND METHODS

The study included 83 patients, aged 63 (54; 70) years, undergoing heart valve surgery with cardiopulmonary bypass.

RESULTS

Postoperative cerebral dysfunction was diagnosed in 37.3% of cases, including perioperative stroke in 3.6% of cases. In cases of aortic stenosis, the frequency of perioperative stroke was 9.5%. The cardioembolic subtype of perioperative ischemic stroke in cardiac valve surgery was most likely. The risk factors of the symptomatic delirium of the early postoperative period are: age over 75 years, preoperative frontal dysfunction, duration of artificial respiratory care more than 20 hours after the surgery.

CONCLUSION

The results suggest the efficacy of preventive use of cytoflavin for reducing the frequency and severity of perioperative stroke and symptomatic delirium of the early postoperative period in heart valve surgery with cardiopulmonary bypass.